Canada - World Health Organization Regional Office for Europe

22
Health systems in transition Canada
Fig. 2.1
Organization of the health system in Canada
Provincial and territorial governments
Regional health
authorities
Mental health
and
public health
providers
Canadian Agency
for Drugs and
Technologies in Health
(1989)
Home care
and
long-term
providers
Ministers and
Ministries or
Departments of Health
Provincial and territorial
prescription drug programmes
Hospital
and
medical services
providers
Canadian Institute
for Health
Information
(1994)
Health Council
of Canada
(2003)
Canadian Constitution
Transfer payments
F/P/T Conferences
of Ministers and
Deputy Ministers of
Health and Committees
Canada Health
Act, 1984
Federal government
Miinister of Health
Canada Health
Infoway
(2001)
Health Canada
Public Health
Agency of Canada
Canadian
Blood Services
(1996)
Statistics Canada
Canadian Institutes
for Health Research
Patented
Medicine Prices
Review Board
Canadian
Patient Safety
Institute
(2003)
Note: Solid lines represent direct relationships of accountability while dotted lines indicate more indirect or arm’s length relationships.
Canada is a constitutional federation with sovereignty, authorities and
responsibilities divided between the federal government and the provincial
governments. With the exception of jurisdiction over hospitals and psychiatric
institutions, which the constitution assigns exclusively to the provinces, the
authority over health or medical care was never explicitly addressed in the
original document, which, in the 1860s, assigned powers to the central and
provincial governments. As a consequence, authority can only be inferred
from a number of other provisions in the constitution. Subsequent judicial
decisions support the view that the provinces have primary, but not exclusive,
jurisdiction over health care (Braën, 2004; Leeson, 2004). Although the three
northern territories have a constitutional status that is subsidiary to the federal
government, they have been delegated primary responsibility for administering
public health care by the federal government.
While the funding, administration and delivery of public health care in
Canada are highly decentralized (Axelsson, Marchildon & Repullo-Labrador,
2007), the federal government retains important “steering” responsibilities
in terms of key dimensions of medicare through the Canada Health Act, the